Detection of unexpected aortic aneurysms by using computed tomography in emergency department: A retrospective analysis of more than 10.000 patients

Aim: This study aims to determine the prevalence of aortic aneurysms (AA) on computed tomography (CT) in the emergency department. 

Material and Methods: A total of 10219 CT images were retrospectively analyzed (7610 thoracic, 6148 abdominal CT). A thoracic aortic diameter greater than 50 mm, an abdominal aortic diameter greater than 30 mm, or an aortic diameter greater than 50% of normal were considered AA. The baseline demographic and clinical characteristics of patients with thoracic AA (TAA) and abdominal AA (AAA) were compared to those without AA. 

Results: TAA was found in 990 (13%) of 7610 patients who had thoracic CT, while AAA was found in 66 (1.07%) of 6148 patients who had abdominal CT.  In aneurysm groups, advanced age (p<0.001), male gender (p<0.001), aortic calcification (p<0.001), hyperlipidemia (p<0.001), coronary artery disease (p<0.001), hypertension (p<0.001), and diabetes mellitus (p<0.001) were more common and significantly different. Smoking was observed more frequently in the group with aneurysms (p<0.001). Among the groups, hospital mortality was higher in the aneurysm group (p<0.001). Surgery was recommended in 30 (3%) of TAA patients whose aortic diameter was greater than 55 mm; however, surgery could be performed in 20 (2%) of these patients. Surgery was recommended for 16 (24%) of AAA patients, but surgery could be performed only in 12 of them (18%). 

Conclusion: Attention to aortic pathologies, particularly AA, in patients undergoing radiological imaging in the emergency department for various reasons allows for the early detection of asymptomatic but potentially fatal aneurysms.